Protocol for motor and language mapping by navigated TMS in patients and healthy volunteers; workshop report
Navigated transcranial magnetic stimulation (nTMS) is increasingly used for preoperative mapping of motor function, and clinical evidence for its benefit for brain tumor patients is accumulating. In respect to language mapping with repetitive nTMS, literature reports have yielded variable results, and it is currently not routinely performed for presurgical language localization. The aim of this project is to define a common protocol for nTMS motor and language mapping to standardize its neurosurgical application and increase its clinical value.
The nTMS workshop group, consisting of highly experienced nTMS users with experience of more than 1500 preoperative nTMS examinations, met in Helsinki in January 2016 for thorough discussions of current evidence and personal experiences with the goal to recommend a standardized protocol for neurosurgical applications.
nTMS motor mapping is a reliable and clinically validated tool to identify functional areas belonging to both normal and lesioned primary motor cortex. In contrast, this is less clear for language-eloquent cortical areas identified by nTMS. The user group agreed on a core protocol, which enables comparison of results between centers and has an excellent safety profile. Recommendations for nTMS motor and language mapping protocols and their optimal clinical integration are presented here.
At present, the expert panel recommends nTMS motor mapping in routine neurosurgical practice, as it has a sufficient level of evidence supporting its reliability. The panel recommends that nTMS language mapping be used in the framework of clinical studies to continue refinement of its protocol and increase reliability.
KeywordsBrain tumor Epilepsy surgery Motor Language Preoperative mapping Transcranial magnetic stimulation
Compliance with ethical standards
Nexstim Plc. (Helsinki, Finland) provided financial support in the form of travel funding to the venue site at BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. The sponsor had no role in the design or conduct of this report.
Conflicts of interest
SK and TP are consultants for Brainlab AG (Munich, Germany) and for Nexstim Plc. (Helsinki, Finland). PL is consultant for Nexstim Plc. HH, PS, and JK are employed by Nexstim Plc. Yet, all authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
Since this is a report from an expert panel, no ethics approval was obtained. This article does not contain any studies with human participants performed by any of the authors.
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